Chemotherapy was previously only used on recurrent disease for palliative purposes. Based on poor results with standard treatment for locoregional advanced disease (stage III and IV), chemotherapy has been included in the treatment strategy for primary tumor within the last two decades.
Chemotherapy has been given neoadjuvantly, concomitantly, and as adjuvant standard treatment. Of these strategies, concomitant therapy has given the greatest survival benefit in meta-analyses. In correspondence with this, it is now routine to give weekly cisplatin with radiation therapy to patients younger than 70 years with ENT cancer stages III and IV.
One of the more significant breakthroughs in treatment is from a study by Bonner et al. using radiotheray plus cetuximab, concomitantly, for squamous-cell carcinoma of the head and neck. Cetuximab is a monoclonal antibody against epidermal growth factor receptor (EGFR). A high level of EGRF in tumor cells is associated with poor prognosis. In the study, radiotherapy plus cetuximab increased locoregional control and reduced mortality in locoregional advanced head and neck cancer compared to radiotherapy alone, without increasing toxicity. This applied primarily to hyperfractionated treatment of oropharyngeal cancer. It is unknown how effective this treatment is compared to radiochemotherapy with cisplatin, which is still considered the standard by many. It is, however, an alternative for patients in stage III or IV older than 70 years.
For advanced laryngeal cancer, neoadjuvant chemotherapy is given to preserve the larynx. For this, a combination of cisplatin and 5FU are used. Neoadjuvant chemotherapy can also be given for rapid symptom relief when airways and food passage are threatened.
Chemotherapy is still given for recurrence when surgery and radiation therapy are not possible. Depending on the medical condition of the patient, single- or multiple-drug regimens are given.
Vermorken et al. have reported that single-drug therapy with cetuximab was active and well tolerated in patients with recurrence and/or metastatic disease which had progressed on platinum therapy. The response rate was 46%, but it is worth noting that none of the patients reached complete response (complete response/partial response/stabile disease (0/13/33)).
Nimoral® is used routinely with radiation therapy. Nimoral® is not a chemotherapy drug, but a "hypoxic cell sensitizer", which render cancer cells more sensitive to radiation therapy.